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Eyesight to the blind: Cheap, fast surgery tackles cataracts

Dr. Sanduk Ruit and Dr. Geoffrey Tabin with patients of the Himalayan Cataract Project
Source: Himalayan Cataract Project
Dr. Sanduk Ruit and Dr. Geoffrey Tabin with patients of the Himalayan Cataract Project

They may look like the "Odd Couple" of ophthalmology, but a Nepalese doctor and his American counterpart's promotion of a dirt-cheap, ultra-fast, assembly-line form of surgery is restoring sight to hundreds of thousands of blind people in developing countries.

"It's really the greatest miracle in medicine," said Dr. Geoffrey Tabin, who with Dr. Sanduk Ruit co-founded the Himalayan Cataract Project to tackle blindness caused by treatable cataracts, a condition that afflicts 20 million people worldwide.

And it's "the most cost-effective intervention in medicine," said Tabin, an Ivy League-Oxford-educated physician and world-class mountain climber. His partner grew up in a small Nepalese village without running water and electricity.

In addition to being a dramatically economical and successful surgery, it's also extremely emotional.

After restoring sight to patients who may have "been blind for 30 or 40 years," Tabin said, he has watched them break into song, dance, tears and hugs once their bandages come off and they realize they can see again.

"And there's an amazing smile. It's something I'll never get tired of," said Tabin, a professor of ophthalmology at the John A. Moran Eye Center of the University of Utah.

He first met Ruit in Nepal more than 20 years ago after becoming aware of and training in the revolutionary cataract surgery that Katmandu-based Ruit was doing. Their work is the subject of a new book, "Second Suns: Two Doctors and Their Amazing Quest to Restore Sight and Save Lives."

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The Himalayan Cataract Project trains doctors, nurses and technicians in developing countries in a system of surgery whose price and Henry Ford-like approach to quickly moving from patient to patient in the same operating room couldn't be more different than the pricey surgical suites of American hospitals.

During the operations, which use about $20 worth of materials per patient, surgeons make a small incision in the side of a patient's eye, and remove the "cloudy elements" that are the blindness-causing cataracts, Tabin said. The surgeon then puts in a lens implant, and the incision closes on its own, without any sutures required.

"It's simple, but delicate," said Tabin, comparing the procedure to NFL quarterback Peyton Manning throwing a touchdown against swarming defenders and making it look easy. "There's so many factors involved, and you have to execute it exactly."

The surgeon then moves onto the next patient lying on an adjacent table in the same room, and one of the blind people waiting their turn in a line of blind people outside is brought in and prepped for surgery while the other patient undergoes the procedure.

"For me, it usually takes five to seven minutes," said Tabin. But "several of our best Nepalis" can do the surgery in "three-and-a-half to four minutes," he added. "A single doctor can often do more than 100 cataract surgeries in a day."

And a day later, "about 80 percent of the patients see well enough to pass the U.S. driver's test," he said.

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"We went in Nepal from having 15,000 surgeries per year in 1994 to 250,000 surgeries in Nepal last year," Tabin said.

Doctors trained by his and Ruit's project also perform the surgery in such countries as Tibet, Bhutan, Burma, Indonesia and in Africa, where disease and other public health problems such as poor nutrition and limited access to clean water fuel cataract-related blindness.

Tabin said he and Ruit created the project because having home-grown physicians do the surgeries in their own countries was a more efficient way of combating the spread of cataract blindness than relying on doctors from Western countries to occasionally visit to perform the operations.

Dr. Sanduk Ruit and Dr. Geoffrey Tabin and patients of the Himalayan Cataract Project
Source: Himalayan Cataract Project
Dr. Sanduk Ruit and Dr. Geoffrey Tabin and patients of the Himalayan Cataract Project

Dr. David Chang, an American ophthalmologist who recently was part of a team with Tabin that did nearly 750 cataract surgeries over five days in Ethiopia, called Tabin and Ruit "the two most unlikely partners you can imagine."

But after coming from opposite ends of the world and cultures, "they link up and collaborate in a way that is doing as much to change cataract blindness as anyone else in the word," said Chang, a University of California, San Francisco professor and past president of the American Society of Cataract and Refractive Surgery.

"It's an inspiring story," he said.

Chang noted there are "economically measurable gains" from the surgical system being promoted by the Himalayan Cataract Project, whose $4 million annual budget is funded by government and private foundation grants, as well as by private philanthropists.

Restoring sight to poor individuals not only puts them in a position where they might be able work; it also enables their caretakers to return to productive work, Chang said. The surgeries also can dramatically increase patients' lifespans, as the blind in the developing world have a life expectancy of just one-third that of people with sight.

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Chang is quoted in "Second Suns" saying that the surgical technique to treat cataracts in the U.S. requires upfront investments by hospitals and other centers of hundreds of thousands of dollars, and the surgeries themselves can cost $3,000 to $5,000 per patient. And nearly all of those cataract surgeries in the U.S. are on people who have not lost their sight, but are having blurred vision at night or other reduced vision issues.

"You never see someone who has gone completely blind from cataracts in America," Tabin said.

Chang said his technique, while being much more expensive than Tabin and Ruit's, wouldn't work on most of their project's patients because their cataracts tend to be so advanced in severity.

"One of the biggest challenges of our lifetimes is [an] epidemic rise of cataract blindness," Chang said. "If a five-minute procedure exists that can restore sight for $20 a patient, then it is the world's most effective way to combat blindness in developing countries."

By CNBC's Dan Mangan. Follow him on Twitter @_DanMangan.

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